Provider Demographics
NPI:1275162398
Name:THORVILSON, JENELLE ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:ELIZABETH
Last Name:THORVILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 DUNROVIN LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1759
Mailing Address - Country:US
Mailing Address - Phone:612-202-1311
Mailing Address - Fax:
Practice Address - Street 1:3460 WASHINGTON DR STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4301
Practice Address - Country:US
Practice Address - Phone:651-688-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist